In my private practice I frequently will get phone calls from a woman telling me that she has lost her sexual desire and that she thinks she should make an appointment for sex therapy. I can tell from her voice that both she and her mate are eager to solve this concern. But before we even finish setting a time for her appointment, I’ll sometimes hear gurgle sounds or crying in the background that tell me there is a baby in her house.

That’s when I stop and ask, “Did you recently have a baby?” The answer is usually, “Yes.” I will follow up with, “So, while you were pregnant, did your interest in sex vary from what it was before you got pregnant?” She’ll often reply, “Oh, yes!”

Some will say that they wanted more and some will say that they wanted less, but very rarely will a recently pregnant woman report that there was no change. That’s when I am thinking to myself, “That’s the effect that babies have on sex. It will be a while before your sexual interest will be back to whatever was normal before the pregnancy.”

I’ll also ask if there were any sexual problems before the pregnancy. If the woman indicates that there were some, I usually encourage her to make an appointment to come in with her mate. It’s really helpful to both new parents to have a place to vent about all the aspects of their relationship that may contribute to how sex is going for them.

For some women, however, it’s really not necessary to set an appointment — at least, not right away. That’s because women with no report of sexual troubles before the birth may simply be at the effect of prolactin. Sometimes a little information is all that’s needed — that and some patience.

So, here’s that information: Prolactin is the hormone that causes breast feeding to happen. It is also a hormone that decreases sexual interest. It is nature’s way of trying to put some space between the birth of one child and the arrival of the next. This allows the first child to get some needed nurturing before another one vies for that same kind of attention. Since many women try to breastfeed for two years, it’s not uncommon to find children spaced about two years apart (though some child psychology experts with whom I’ve consulted have recommended three years for the benefit of the eldest child and for the mom who then gets a bit of a break).

So, women who are breast feeding have a natural impediment to having sexual interest. It does not mean that all women will feel this way. But, most do find the thought of sexual contact tough to manage, particularly when they couple the effect of prolactin with getting only four hours of sleep in a row day after day.

Prolactin does not drop back to pre-pregnancy rates the day that breast feeding stops. It may take some time. If, after a few months of no breast feeding (and decent amounts of sleep) a woman does not have an increase in her sexual desire, she can have a prolactin blood test to see what her level is. A physician may recommend treatement with Dostinex (cabergoline) if the level is abnormally high. Of course, it’s always wise to see how the couple is doing in their overall relationship since that can have an effect of sexual desire as well.

Don’t short-circuit breast feeding. Pediatric experts agree that breast feeding is a pathway to strengthening infant health. I do recommend that couples understand that for the sake of their child, they should adjust their sexual expectations and widen the playing field to allow many sexual options as part of their sexual relationship.

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